Organization
30 MEDICAL GROUP/SGSL
Active
Other names
VANDENBERG PHCY
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR MORALES (CHIEF DHA PASS)
(210) 536-6650
Entity
Organization
Contact information
Practice address
338 S DAKOTA AVE, BLDG 13850, VANDENBERG AFB, CA 93437-6307
(805) 606-7440
(805) 734-9842
Mailing address
338 S DAKOTA AVE, BLDG 13850, VANDENBERG AFB, CA 93437-6307
(805) 606-7440
(805) 734-9842
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2115792
PK
—
Enumeration date
09/20/2006
Last updated
01/22/2016
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